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Delayed transfer from emergency to wards cost lives: Study

Rajeev Choudhury

It is a well-known fact that delays in transferring patients to hospitals from emergency rooms harm them; however, the researchers for the first time have reported that delaying transfer from emergencies by six or more hours increases the risk of death within 30 days.

The study, reported in the Emergency Medicine Journal recently, the researchers led by Simon Jones of the Department of Population Health, New York University School of Medicine, accessed data from the NHS England’s Hospital Episode Statistics record of emergency attendances (HES AE) linked to the Hospital Episode Statistics admitted patient care record (HES APC) and Office of National Statistics’ population mortality data between April 2016 and March 2018 and found that of 5,249 891 individual patients, who constituted the study’s dataset, a total of 433,962 deaths occurred within 30 days.

The researchers observed that the crude 30-day mortality rate increased by 8.71% from 5 hours after the time of arrival at the emergency department and this rise increased up to 12-hour delay in transferring the patient to the wards.

The researchers further observed that in the case of waiting between 6-8 hours, the mortality rate increased by 8% while in the case of 8-12 hours wait the mortality rose by 10%.

For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from the time of arrival at the ED, there is one extra death, the researchers concluded.

Dr Derek Prentice of the Royal College of Emergency Medicine, London attributes the delay in transfers to budgetary curtailment in the public health sector.

“For at least the last 12 years and more, we have seen cuts after cuts to the budget of the NHS, leading to reduced bed numbers and staffing,” he says.

“This is bad enough in itself but has been further compounded by repeated large reductions in central government financial support to local authorities, with a devastating impact on social care,” he adds.

“The result has been fewer beds in hospitals and a grave lack of social care provision for those patients ready for discharge, or as it is called, exit block and delayed timely admission,” Dr Prentice added.

In a commentary published in the same journal, Dr Prentice articulated that the authors defined the rise in mortality as starting at 5 hours and so a 4-hour threshold seems both justifiable and sensible.

It is interesting to note that while the 4-hour target initially seemed to be an arbitrary figure, the paper’s graph plotting mortality rate against time in the emergency department clearly shows a steady rise after 4 hours, he added.


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